Masaki Mori

Benign Cystic Teratoma of the Parotid Gland: A Case Report

BACKGROUND Mature cystic teratomas of the major salivary glands are rare. This report describes a case of a mature cystic teratoma of the left parotid gland, including the cytologic and histopathologic findings. CASE A 17-year-old young woman presented with a slow-growing left parotid mass that had been present for 4 years. Preoperative fine needle aspiration cytology showed the presence of acinar and ductal cells, foamy cells and multinucleated giant cells. Imprint cytology of the surgical material showed the presence of some squamous cells and sebaceous gland-like cells with hair shafts. Cellular atypia was inconspicuous. Grossly, the 3-cm lesion was unicystic and embedded within the parotid gland parenchyma. Microscopically, the inner surface of the cyst was lined with keratinized squamous epithelium. The cyst wall contained skin adnexa such as sebaceous, eccrine and apocrine glands, as well as hair follicles. Some mature cartilage tissue was also detected. Foreign body granulomatous change was seen focally. No immature tissue or malignant transformation was found. CONCLUSION There is no previous report describing the cytologic findings of a mature cystic teratoma of the parotid gland. Mature cystic teratomas should therefore be considered in the differential diagnosis of a cystic lesion of the parotid

Sarcomatoid salivary duct carcinoma of the submandibular gland: a case report.

BACKGROUND Sarcomatoid salivary duct carcinoma (sarcomatoid SDC) is a rare subtype of SDC. We encountered 1 case of sarcomatoid SDC that developed from a submandibular gland pleomorphic adenoma, and we herein report our findings. CASE A 42-year-old female had tumentia and pain in the right submental area, and therefore she underwent a close examination, wherein a right submandibular gland neoplasm was detected. Surgery for removing the right submandibular gland was performed in addition to neck dissection. Cytology showed typical findings of conventional SDC. Moreover, isolated and scattered large spindle cells and multinucleated cells were also detected along with atypical epidermal cell clumps showing keratinization. From a histologic perspective, it appeared to be sarcomatoid SDC that developed from a pleomorphic adenoma and also involved a squamous cell carcinoma component. CONCLUSION This is the first report on the cytologic findings ofa case of sarcomatoid SDC with a squamous cell carcinoma component. When sarcomatoid cells appear in the cytology along with findings of typical SDC, sarcomatoid SDC should thus be considered. Furthermore, squamous cell carcinoma component may be involved as in the present case, so it is necessary to be aware of the possibility thereof.

Collagenous Spherulosis Associated with Adenomyoepithelioma of the Breast

BACKGROUND Collagenous spherulosis (CS) associated with an adenomyoepithelioma (AME) of the breast is rare. This report describes a case of CS associated with an AME of the right breast, including the cytologic and histopathologic findings. CASE A 51-year-old female presented with a slow-growing left breast mass that had been present for 5 months. A preoperative core needle biopsy showed the presence of layers or sheaths of myoepithelial cells around epithelial-lined spaces. Imprint cytology of the surgical material showed the presence of bundles of spindle cells with an admixture of epithelial cells. Spherical structures were also found. They were translucent or slightly light green with Papanicolaou staining and metachromatic with Giemsa staining. Grossly, the 1.5-cm lesion was solid and embedded within the breast parenchyma. Microscopically, it was composed of spindle or polygonal cells with eosinophilic cytoplasm and an epithelium lining spaces with many spherical structures. The spindle or polygonal cells were positive for myoepithelial markers and the epithelium was positive for epithelial markers by immunohistochemistry. CONCLUSION There is no previous report describing the cytologic findings of CS associated with an AME of the breast. AMEs should therefore be considered an underlying pathology of CS of the breast.

Cytological Features of Carcinosarcoma ex Pleomorphic Adenoma of the Parotid Gland: A Case Report

Background: Carcinosarcoma of the salivary gland is an extremely rare tumor composed of carcinomatous and sarcomatoid components. This report describes the cytological and pathological findings of a case of carcinosarcoma ex pleomorphic adenoma arising in the right parotid gland. Case: A 47-year-old female visited a hospital with swelling of the right parotid region, slight pain and facial palsy. Fine-needle aspiration smears showed both clustered epithelium-like cells and singly scattered cells in a necrotic background. The cells, especially the latter, exhibited significant cellular pleomorphism and had irregularly shaped nuclei. Myxoid stroma-like cell clusters without cellular atypism were also seen. The right parotid gland was resected, and the tumor tissue was histologically diagnosed as carcinosarcoma ex pleomorphic adenoma. Conclusion: The cytological findings of carcinosarcoma ex pleomorphic adenoma have been reported in very few cases. In the present case, various components, including the presence of atypical epithelium-like cell clusters and singly scattered atypical cells with stromal components on cytological specimens, led to consideration of the diagnosis of carcinosarcoma ex pleomorphic adenoma.

Pseudo-continuous arterial spin labeling MR images in Warthin tumors and pleomorphic adenomas of the parotid gland: qualitative and quantitative analyses and their correlation with histopathologic and DWI and dynamic contrast enhanced MRI findings

PurposeWe investigated the correlation between tumor blood flow (TBF) and histopathologic features of Warthin tumors (WTs) and pleomorphic adenomas (PAs) to determine the TBF in the differential diagnosis of these tumors and evaluated how well pCASL-MRI can differentiate PAs from WTs compared to conventional MRI.MethodsThe ADC, time intensity curve (TIC) pattern of dynamic contrast enhancement, and pCASL (visual assessment and TBF of the MR images of 10 WTs and 13 PAs) were reviewed. We compared the pCASL and ADC or TIC patterns in WT and PA images. Tissue sections were stained with CD34 to evaluate microvessel density (MVD). The TBF and MVD results were compared. The Mann-Whitney U test was used to compare the TBFs, ADCs, and MVDs of these tumors. The diagnostic accuracy was determined by analyzing the receiver operating characteristic curve.ResultsOn visual assessment, the signal intensity was higher in all but three cases of WT. The TBF and MVD of the WTs were significantly higher (both, p < 0.01) than the PAs, and the ADC was significantly lower (p < 0.01). Many WTs had early enhancement of the TIC pattern and high washout; many PAs had gradual enhancement. The diagnostic accuracies of visual analysis, TBF, and ADC for differentiation between WTs and PAs were 91.3, 95.7, and 87.0%, respectively.ConclusionsThe TBF were significantly higher in WTs than in PAs, and there was a positive correlation between TBF and MVD. Moreover, pCASL-MRI provides more accurate imaging than conventional MRI to differentiate WTs and PAs.

Evaluation of the benefit and use of the new terminology in endometrial cytology reporting system

The introduction and establishment of a new classification system for endometrial cytology, the “New Terminology in Endometrial Cytology (NTEMC) system,” which is based on the Bethesda System for uterine cervical cytology, has recently been reported. However, the clinical management for new categories in the NTEMC system, particularly atypical endometrial cells (ATEC), has not been clarified. The objective of the present study is to determine how the ATEC category should be treated and whether the introduction of the system has decreased the number of unnecessary endometrial biopsies.

Liquid-based cytology in the diagnosis of Langerhans cell sarcoma: A case report

Langerhans cell sarcoma (LCS) is an extremely rare malignant dendritic cell neoplasm with Langerhans cell differentiation. Conventional cytology, based on cell morphology alone, cannot render a cytological diagnosis of LCS because immunochemical analysis is essential to identify the Langerhans cell immunophenotype. We present a case illustrating the value of liquid‐based cytology with immunocytochemistry as compared with conventional cytology, along with histological and immunohistochemical findings. A 92‐year‐old woman presented with a 1‐month history of progressive right cervical lymphadenopathy. Cytology of a fine needle aspiration sample from the right superior internal jugular lymph node revealed proliferation of atypical, pleomorphic, and histiocytoid cells with one or more irregular‐shaped nuclei. Compared with conventional cytology, liquid‐based cytology demonstrated more clustered and spatial cells, slightly less marked nuclear atypia, more intense light green staining of the cytoplasm, and a clearer background. Immunocytochemical analysis of the abnormal cells revealed expression of vimentin, CD1a, langerin, CD68, and S‐100. The combined morphologic and immunocytochemical results strongly indicated LCS. Histological and immunohistochemical examination of a subsequent excisional biopsy specimen closely coincided with the results of liquid‐based cytology. Thus, this technique, including the use of immunocytochemistry, is very useful and valuable for the pathological diagnosis of nonepithelial and hematopoietic neoplasms. There are subtle but considerable differences in cell morphology between conventional and liquid‐based cytology; these differences include clusterability, spatial findings, dyeability, and atypism as illustrated in this case of LCS.